Notes From Leogane No. 20: Postscript

Dear Family and Friends:

This past Saturday I sent you No. 20 - Achte Pen - about lymphatic filariasis. Little did I know that two days later a team of American urological surgeons, anesthesiologists, and OR nurses would come to Hopital Sainte Croix to perform hydroceles surgeries. They performed four yesterday, and have five scheduled for today. They will be at HSC through Friday.

Most of the patients are men.  Genital swelling from LF primarily affects men, but female genitalia also can become enlarged. In hydroceles surgery, fluid is drained from the impacted area, followed by surgical repair/reduction of the enlarged anatomical area. By the end of this week, 13-15 patients will have a new lease on life.

When I was reading about filariasis to prepare NFL 20, one article commented that in various parts of Haiti the mass drug administration ("MDA") efforts were not accepted by some because they believed the grotesque attack on people's bodies was from voudu or voodoo.  (In Haiti, many don't even use this word to refer to this Haitian religious practice.  Rather, it is called "following the loa" or "serving the loa".)  

I thought it best not to include assertions about the "vodou" etiology of LF in the Note, because after all it was probably just the view of a few vodou followers. Then on Saturday we had three guests for dinner. One was the Haitian translator for the group. During dinner, I just happened to mention that on my way out of Haiti, as I did last year, I would be going next door to the LF clinic to get a six or seven pill anti-LF "super shot" to take the first day I arrived back in the States. This by the way is most probably an unnecessary precaution, because it would be a highly unlikely for a three months stay here to lead to LF infection.

One of the dinner guests was not familiar with filariasis, so I summarized for him the worms maturation process that causes the clogging of the lymphatic system. After my non-medical explanation, the translator guest spoke up. He said his younger twenty-eight year old sister had LF in her right leg. He indicated with his hands that the diameter of her leg was more than twice that of the other leg. He said it was vodou that got her when she walked out the front door one day and stepped on a piece of glass right foot. He said her leg ballooned up shortly after that. He was adamant that the slow, progressive development of microscopic filial larvae into adult worms had nothing to do with his sister's affliction. Now I have a better understanding for why some Haitians have not followed through with all 5-6 years of the MDA regimen.  I hope it has not been too many.

I hope this postscript finds you and your loved ones in good health and spirits.

Peace,

David 

24 April 2012